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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: o ! a Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Address: (V � LIE 5G1 c'_ 02( Gc Legal Description: Residential 'L -- Property Tax ID #: ti JQ i — W aci - W0— 7 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: J\ C C I r 1 I 1 -fir l,> {, l 5 LL) 4-h 10 r"L u. -- CONSTRUCTION INFORMATION: Additional work to be performed under this permit —check a appy: HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors 11 Electric ❑ Plumbing Sprinklers E Generator © Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction: $ � . oc) _ Utilities: Sewer ©Septic Building Height: OWNI RAESSEE: CONTRACTOR: Name -..."Jo Iz5F)ni0 Name: Shyan Wojtczak Address: ty I 7 'SC c-Tyc' , C c TAO D(, Company: Cool Air Solutions of Florida, Inc. City: 6:�Cj -�) iCc Ce State: eL_ Zip Code: 3LIgS l Fax: Phone No. �10�1 • `1 J �i �iCi 9 Address: 6903 Cabana Lane City: Fort Pierce State :FL Zip Code: 34951 Fax: 772-801-5398 Phone No. 772-6340491 E -Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E -Mail: coolairsol@gmail.com State or County License: CAC# 1819009 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: BONDING COMPANY: Not Applicable Name: Address: Address: City: City: Zip: Phone: 9 Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the }obsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. � cx � e Signatu of Owner/ Les ontractor as Agent for Owner Signature of ontractor/Lic older j STATE OF FLORIDA C�Gf STATE OF FLORIDA. t�1Csr�� COUNTY OF COUNTY OF The f ng instru ent was acknowledge efore me Tday The forging instrument wa acknowledge before me � day OC, Y'00@-- 20L6 by thi of C,7 20 by this of JName of person making statement arae of person ma ing statement Personally Known OR Produced Identification Personally Known OR Produced Identification_ Type of Iden ification C{ Type of Identi ication I Produced �'/�� Producedf 01 (Signat of Notary ublic- Sta a of Florida } Erich Daniel Krach tY (Signat of Notary Public- S to o or�la) Erich Daniel Krach OTARY PUBLIC Commission No. oc —STATE OF FLORID ` r�C-(a� NOTARY PUBLIC Commission No. J 22 S NATE OF FLOft![ GGIIJ552, W =Comm# GG4ff5S25 Comm## �i ti� s�Ncr �gl Ex fres 5/971202 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17